RELEASE AND QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

        I, _________________________, of legal age, and with residence address at

___________________________________________________________, after having been duly
sworn to in accordance with law, do hereby depose and state:

1. That I am a former employee of KUEHNE + NAGEL, INC., a domestic

corporation organized under Philippine laws with principal offices at the 6 th Floor, Four Ecom
Center Bldg., Pacific Drive, Moa Complex, Pasay City, (hereinafter referred to as the
“CORPORATION”), having been connected therewith as (state position) from (state starting date of
employment) to (state end date of employment);

2. That I was separated from KUEHNE + NAGEL, INC., having tendered my

voluntary resignation on (state date of resignation);

3. That I hereby acknowledge that I have received from said KUEHNE +

NAGEL, INC., all benefits due me under the Retirement Plan of the Corporation as a resigned
employee in the total amount of (state amount in words) (PhP ), which is apart from other
statutory benefits such as wages, 13 month pay, unpaid leaves which I already acknowledged to
th

have received and declared in a separate release and quitclaim;

4. That by reason of my receipt of all the benefits due me from KUEHNE +

NAGEL, INC., I hereby therefore RELIEVE, RELEASE and FOREVER DISCHARGE said
KUEHNE + NAGEL, INC., and/or any of its stockholders, partners, directors, agents, officers
and employees from any and all claims or liabilities to me by way of unpaid wages, 13th month
pay, unpaid leaves, benefits under the Retirement Plan and other benefits as may be due me or
incident to my employment with the said company; and I further declare that I have no more
claim, right or action of whatsoever nature, whether past, present or contingent, against said
KUEHNE + NAGEL, INC., or any of its stockholders, partners, directors, agents, officers and
employees in connection with, or incident to, my employment with the said company;

5. That I hereby acknowledge and declare that the said amount of

PhP__________ mentioned in paragraph 3 represents complete and full settlement of the
benefits accorded to resigned employees under the Retirement Plan of the said
Corporation;

6. That I executed this instrument freely and voluntarily without any moral or
physical threat, coercion or promise of reward in any form.

        IN WITNESS WHEREOF, I hereby affixed my signature this ____ day of December, 2022
at __________________, Philippines.

FULL NAME   
           Affiant

SIGNED IN THE PRESENCE OF:

____________________________ ____________________________
 ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

_______________________ ) S.S.

BEFORE ME, a Notary Public for and in _________________, this ____ day of
________________, 2022, personally appeared (name of employee) with Driver’s License
No. ____________ issued at ______________ on ________________, known to me to be the
same person who executed the foregoing instrument and acknowledged to me that the same is his
free and voluntary act and deed,

The foregoing RELEASE AND QUITCLAIM consists of two (2) pages, including this
page on which this acknowledgement is written has been signed on the left margin of each and
every page by the party and the witnesses.

WITNESS MY HAND and SEAL at __________________, Philippines.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2022.